Antibiotic use results in resistance even for individual children
Article Outline
- Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon-White R, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ 2007;335;429-33
- References
- Copyright
Chung A, Perera R, Brueggemann AB, Elamin AE, Harnden A, Mayon-White R, et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. BMJ 2007;335;429-33
Question
What is the effect of prescribing antibiotics for acute respiratory infection on the prevalence of antibiotic resistant bacteria in an individual child?
Design
Observational cohort study with follow-up at 2 and 12 weeks.
Setting
General practices in the United Kingdom.
Participants
119 children with acute respiratory tract infection, 71 of whom received a β-lactam antibiotic.
Outcomes
Antibiotic resistance, as assessed by the minimum inhibitory concentration (MIC) for ampicillin and presence of the ICEHin1056 resistance element in up to 4 isolates of Haemophilus spp recovered from throat swabs at recruitment, 2 weeks, and 12 weeks.
Main Results
Prescribing amoxicillin to a child in general practice more than triples the mean MIC for ampicillin (9.2 μg/mL vs 2.7 μg/mL; P = .005) and doubles the risk of isolation of Haemophilus isolates with homologues of ICEHin1056 (67% vs 36%; relative risk = 1.9; 95% confidence interval = 1.2 to 2.9) 2 weeks later. This increase was transient, and by 12 weeks, ampicillin resistance had fallen close to baseline. However, the isolation of resistant Haemophilus ranged from 35% of children at recruitment to 83% at some point in the study, regardless of treatment status.
Conclusions
The short-term effect of amoxicillin prescribed in primary care is transitory in the individual child, but is sufficient to sustain a high level of antibiotic resistance in the population.
Commentary
This elegant observational study confirms that antibiotic resistance is associated with individuals prescribed antibiotics in the community, and provides new insight into the processes involved: the gene encoding β-lactamase selected out by antibiotics among bacteria being transferred to Haemophilus. It is difficult to imagine how confounding could have biased these data. There is now a well-established body of evidence from meta-analyses of trials demonstrating at best a modest benefit of antibiotics for common bacterial acute respiratory infections.1, 2, 3, 4 With this study, we are now closer to quantifying the harm done from antibiotics to the individual, not just the community. This moves us beyond worrying that antibiotics are simply a nonrenewable resource (where the problem is that many doctors treating sick children feel an urge to provide the best possible care, covering all possible outcomes, whatever the potential consequences for antibiotic resistance).5 Now we know of the extra risk to the individual patient of prescribing antibiotics for a non–life-threatening illness—resistance will result in the antibiotic being unavailable for any future life-threatening illness. Hopefully, recognition of this threat will lead to lower community antibiotic prescribing rates.
References
- . Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2005;3:CD000247
- . Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2004;4:CD000245
- . Antibiotics for sore throat. Cochrane Database Syst Rev. 2006;4:CD000023
- . Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2004;1:CD000219
- . The tragedy of the commons. Science. 1968;162:1243–1248
PII: S0022-3476(07)01148-1
doi:10.1016/j.jpeds.2007.12.004
© 2008 Mosby, Inc. All rights reserved.
